Silvana Federici1, Lorenzo DE Biagi2, Simona Straziuso1, Ernesto Leva3, Giulia Brisighelli3, Girolamo Mattioli4, Luca Pio4, Pietro Bagolan5, Giorgia Totonelli5, Bruno Noccioli6, Elisa Severi6, Pierluigi Lelli Chiesa7,8, Gabriele Lisi7,8, Antonino Tramontano9, Carolina DE Chiara9, Carmine Del Rossi10, Giovanni Casadio10, Mario Messina11, Rossella Angotti11, Antonino Appignani12, Mirko Bertozzi12, Fabio Rossi13, Valeria Gabriele13, Andrea Franchella14, Veronica Zocca14. 1. Pediatric Surgery Unit, Infermi Hospital, Rimini, Italy. 2. Pediatric Surgery Unit, Infermi Hospital, Rimini, Italy - ldeb76@libero.it. 3. Pediatric Surgery Department, IRCCS Ca' Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy. 4. Pediatric Surgery Unit, Giannina Gaslini Institute, Genoa, Italy. 5. Medical and Surgical Neonatology Department, Bambin Gesù Children's Hospital, Rome, Italy. 6. Neonatal Surgery Unit, Meyer University Children's Hospital, Florence, Italy. 7. Pediatric Surgery Department, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy. 8. Pediatric Surgery Unit, Spirito Santo Hospital, Pescara, Italy. 9. Neonatal Surgical Unit, Santobono Children's Hospital, Naples, Italy. 10. Pediatric Surgery Unit, Maggiore University Hospital of Parma, Parma, Italy. 11. Pediatric Surgery Unit, Department of Medical Sciences, Surgery, and Neuroscience, University of Siena, Siena, Italy. 12. Pediatric Surgery Unit, University of Perugia, Perugia, Italy. 13. Pediatric Surgery Department, Ospedale Maggiore della Carità, Novara, Italy. 14. Pediatric Surgery Department, Sant'Anna Hospital, Cona, Ferrara, Italy.
Abstract
BACKGROUND: Necrotizing enterocolitis (NEC) is the most common surgical emergency in newborns and it is still a leading cause of death despite the improvements reached in the management of the critically ill neonate. The purpose of this study was to evaluate risk factors, surgical treatments and outcome of surgical NEC. METHODS: We retrospectively evaluated a multicentric group of 184 patients with surgical NEC over a period of 5 years (2008-2012). Indications to operation were modified NEC Bell stages IIIA or IIIB. The main outcome was measured in terms of survival and postsurgical complications. RESULTS: Data on 184 patients who had a surgical NEC were collected. The majority of patients (153) had a primary laparotomy (83%); 10 patients had peritoneal drainage insertion alone (5%) and 21 patients had peritoneal drainage followed by laparotomy (12%). Overall mortality was 28%. Patients with lower gestational age (P=0.001), lower birth weight (P=0.001), more extensive intestinal involvement (P=0.002) and cardiac diseases (P=0.012) had a significantly higher incidence of mortality. There was no statistically significant association between free abdominal air on the X-ray and mortality (P=0.407). Mortality in the drainage group was 60%, in the laparotomy group and drainage followed by laparotomy group was of 23-24% (P=0.043). There was a high incidence of stenosis (28%) in the drainage group (P=0.002). On multivariable regression, lower birth weight, feeding, bradycardia-desaturation and extent of bowel involvement were independent predictors of mortality. CONCLUSIONS: Laparotomy was the most frequent method of treatment (83%). Primary laparotomy and drainage with laparotomy groups had similar mortalities (23-24%), while the drainage alone treatment cohort was associated with the highest mortality (60%) with statistical value (P=0.043). Consequently laparotomy is highly protective in terms of survival rate. Stenosis seemed to be statistically associated with drainage. These findings could discourage the use of peritoneal drainage versus a primary laparotomy whenever the clinical conditions of patients allow this procedure.
BACKGROUND:Necrotizing enterocolitis (NEC) is the most common surgical emergency in newborns and it is still a leading cause of death despite the improvements reached in the management of the critically ill neonate. The purpose of this study was to evaluate risk factors, surgical treatments and outcome of surgical NEC. METHODS: We retrospectively evaluated a multicentric group of 184 patients with surgical NEC over a period of 5 years (2008-2012). Indications to operation were modified NEC Bell stages IIIA or IIIB. The main outcome was measured in terms of survival and postsurgical complications. RESULTS: Data on 184 patients who had a surgical NEC were collected. The majority of patients (153) had a primary laparotomy (83%); 10 patients had peritoneal drainage insertion alone (5%) and 21 patients had peritoneal drainage followed by laparotomy (12%). Overall mortality was 28%. Patients with lower gestational age (P=0.001), lower birth weight (P=0.001), more extensive intestinal involvement (P=0.002) and cardiac diseases (P=0.012) had a significantly higher incidence of mortality. There was no statistically significant association between free abdominal air on the X-ray and mortality (P=0.407). Mortality in the drainage group was 60%, in the laparotomy group and drainage followed by laparotomy group was of 23-24% (P=0.043). There was a high incidence of stenosis (28%) in the drainage group (P=0.002). On multivariable regression, lower birth weight, feeding, bradycardia-desaturation and extent of bowel involvement were independent predictors of mortality. CONCLUSIONS: Laparotomy was the most frequent method of treatment (83%). Primary laparotomy and drainage with laparotomy groups had similar mortalities (23-24%), while the drainage alone treatment cohort was associated with the highest mortality (60%) with statistical value (P=0.043). Consequently laparotomy is highly protective in terms of survival rate. Stenosis seemed to be statistically associated with drainage. These findings could discourage the use of peritoneal drainage versus a primary laparotomy whenever the clinical conditions of patients allow this procedure.
Authors: Sonja Zamrik; Federica Giachero; Michael Heldmann; Kai O Hensel; Stefan Wirth; Andreas C Jenke Journal: Biomed Res Int Date: 2018-11-13 Impact factor: 3.411